Gallbladder pain can happen without gallstones
DEAR DR. DONOHUE: After six months of off-and-on abdominal pain and ultrasounds of liver, spleen, gallbladder, kidneys and lungs plus a colonoscopy and gastroscopy (all negative), I have been diagnosed with sphincter of Oddi dysfunction. My doctor wants me to have a HIDA scan with CCK. Investigating this on the Internet, I find the diagnosis and scan to be controversial. Can you give me any information? Could it be treated with diet? — E.S.
ANSWER: Sphincters (SFINK-turs) are rings of muscle that encircle structures to keep them closed. There is a sphincter at the bottom of the esophagus, one at the outlet of the urinary bladder and another at the end of the rectum. They’re all over the place. The duct that drains bile from the gallbladder and digestive enzymes from the pancreas also has a sphincter, the sphincter of Oddi. It keeps that duct closed so that intestinal juices won’t flow into the gallbladder and pancreas. (I’ve been a doctor for 40 years, and I finally made myself look up who Oddi was. He was an Italian physician.)
When a person eats a meal with fat or protein in it, the sphincter of Oddi relaxes to allow bile and pancreatic digestive enzymes to enter the small intestine to begin the digestion of food.
Sphincter of Oddi dysfunction is a diagnosis accepted by most doctors. It’s intermittent spasms of that muscle. The spasms produce pain similar to the pain of a gallbladder attack. If spasm can be demonstrated by a HIDA (or similar) scan, then the diagnosis rests on firmer ground. It rests on truly firm ground if the pressure in the sphincter is measured and found to be high.
A low-fat diet sometimes relieves sphincter of Oddi dysfunction. Sometimes nitrite medicine, the same used for angina heart pain, relaxes the sphincter. An incision of that muscle by way of a scope and accompanying instruments almost always works.
CCK is cholecystokinin, a hormone that contracts the gallbladder and sends a jet of bile into the intestine.
DEAR DR. DONOHUE: Please write about infectious arthritis. I found it in a doctor’s book, and I think I have it. Fifty-five years ago, after delivering twins, I started having big boils break out every so often, usually near my hips. They dry up after a few days. I have had them come up on me all these years. — R.B.
ANSWER: I don’t want to disappoint you, but I don’t believe you have infectious arthritis, a joint infection that causes swelling, redness, warmth and pain of the affected joint. You’re describing recurrent boils, a staph infection of the skin.
I can give you a program for recurring boils. A boil starts out as an infection of a hair follicle, the pore through which a hair emerges. Typically, a boil reaches a certain size and then drains and heals. Large boils are carbuncles. They present bigger troubles. People with carbuncles can have a fever and feel lousy. It has to drain in order to heal, and, if it doesn’t do so spontaneously, a doctor has to do it for you.
If you are getting crop after crop of boils, you need to be on an antibiotic, one that is effective against the resistant staph germ. You should clean your skin with a disinfectant, like chlorhexidine or hexachlorophene. Change sheets, towels and washcloths daily. Cover a draining boil or carbuncle with a gauze dressing. Often you will need a doctor to examine you and to prescribe medicine that removes staph from the nose, a place of sanctuary for staph germs.
DEAR DR. DONOHUE: I have heard you shouldn’t drink tea because it causes kidney stones. Can you enlighten me on this? — M.P.
ANSWER: The most common kind of kidney stone is a calcium oxalate stone. If people have had that kind of stone, their doctor might tell them to go easy on tea. People who have never had a kidney stone can drink tea without fear. Tea is one of the world’s most popular drinks. It also has many health benefits. Its fluoride protects teeth, and its antioxidants protect many other organs, including arteries.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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